• C C Wu, C H Shih, W J Chen, and C L Tai.
• Department of Orthopedics, Chang Gung Memorial Hospital, 5 Fu-Hsin St. 333, Kweishan, Taoyuan, Taiwan. ccwu@cguaplo.cgu.edu.tw
• Arch Orthop Trauma Surg. 1999 Jan 1; 119 (5-6): 303-7.

AbstractRigid intramdullary nailing with cancellous bone grafting provided by intramedullary reaming was prospectively used to treat femoral shaft aseptic nonunions after plating. Indications for this technique were a femoral shaft nonunion with an inserted plate, no previous infection sign in the treatment course, less than 1.5 cm shortening, and no segmental bony defects. After the plate was removed, a flexible guidewire was inserted antegradely. The local wound was closed, and intramedullary reaming was done as widely as possible until some resistance to it occurred. Finally, a rigid intramedullary nail was inserted. Twenty-four consecutive patients were treated with this regimen, and 21 were followed-up for at least 1 year (range 1-5 years). All 21 nonunions healed with a union rate of 100% (21/21). The time to union was 4.5 +/- 1.0 months. There were no significant complications. We conclude that for indicated cases, reaming bone grafting is a very effective technique and avoided donor site morbidity. Therefore, whenever possible, this technique could be considered first.

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